HISTORY OF DESCRIPTION OF KAWASAKI’S DISEASE. TOMISAKU KAVASAKI – FAMOUS JAPANESE PEDIATRIC, AUTHOR OF SYSTEMIC VASCULITIS IN CHILDREN
Kawasaki disease is a systemic vasculitis of unknown etiology, acute onset in infancy or early childhood, with a primary lesion of the coronary arteries. Syndrome or Kawasaki disease is more often observed in children under the age of 5 years and is recognized as the leading cause of acquired heart diseases in children – primarily the pathology of the coronary arteries, which in some cases can persist throughout the patient’s life, leading to coronary heart disease and myocardial infarction in children and young age. Currently, the number of adults with coronary artery disease due to childhood Kawasaki disease, who are hospitalized for acute myocardial infarction for coronary artery bypass grafting or interventional procedures, is increasing. Dilation (ectasia) or aneurysm of the coronary arteries develops in 25% of children who have not received adequate therapy. Treatment, begun in the first 10 days of the disease with the use of immunoglobulin for intravenous administration, reduces this risk to 3-5%. In this regard, two problems of this disease are important:
1. The need to establish a diagnosis and prescribe treatment no later than the 10th day of the disease to reduce the risk of coronary artery damage.
2. The need for many years of monitoring and treatment of children with coronary artery aneurysms to reduce the risk of coronary thrombosis, timely detection of coronary artery stenosis, prevention and treatment of coronary heart disease.
History of Kawasaki’s disease description. Tomisaku Kawasaki – famous Japanese pediatrician, author of systemic vasculitis in children
Tomisaku Kawasaki for the first time published in English in 1974 a report on 50 cases of a new disease involving vascular and cardiovascular diseases. Since then, a disease called Kawasaki has become the leading cause of acquired heart disease in children in North America and Japan.
T. Kawasaki first saw unusual symptoms of a future new disease in January 1961 in a boy aged 4 years. Describing the diagnosis of this disease, Kawasaki noted that he first encountered such a set of symptoms and could not find any such description in any available medical literature. At that time, Kawasaki had no choice but to write in the column “diagnosis of the disease” – an unknown disease. The child had a prolonged febrile temperature, cervical lymph nodes were also enlarged, there were lip cracks with bleeding, a bright red tongue, conjunctivitis, exanthema, hyperemia and swelling of the palms and soles. Later, peeling of the skin of the extremities occurred. The child was treated with penicillin and glucocorticoids. The temperature decreased after 2 weeks, then other symptoms gradually disappeared. In 1962, Kawasaki already observed 6 patients with a similar clinical picture. Polymorphic exudative erythema, Stevens-Johnson syndrome, and even juvenile rheumatoid arthritis were a preliminary diagnosis. Initially, Kawasaki disease was considered a benign disease, limited only by manifestations from the skin and mucous membrane. This even reflects one of the names that Kawasaki used to describe several cases – “scarlet fever-like syndrome with peeling” – during his report in 1962 at a meeting of the Association of Japanese Pediatricians in Chiba. In 1964, when presenting 22 cases, Kawasaki used the term “mucocutaneous-ocular syndrome”.
Examining and observing these children, Kawasaki began to suspect that he was faced with a new, previously unknown disease. In fact, the symptoms of this disease have been actively described in Japan since the 50s of the last century. But only after a comprehensive description of the symptoms of T. Kawasaki’s disease, after the publication of a series of his works and the creation of a nationwide registry called “Kawasaki’s Case History” in 1970, scientists and practitioners were able to combine all these disparate cases of the disease into a single nosological unit.
Only a few years after the first articles on the “new disease” appeared in Japan did clinical and pathomorphological evidence of serious heart damage in some patients, including sudden death from thrombosis of coronary aneurysms, appear.
By 1967, Kawasaki had already described 50 cases of the disease, which was accompanied by fever, nonexudative conjunctivitis, erythema of the palms and soles, and lymphadenopathy of the cervical region. This symptom complex was called “acute febrile oculo-oro-kutaneoacrodesquamative syndrome with non-purulent cervical lymphadenitis and without it,” but from the moment of description, doctors began to use the eponym “Kawasaki disease”. Describing the symptoms of a “new” disease, Kawasaki had many opponents who disputed the scientist’s opinion about the independent nature of the disease. The main discussion concerned the relationship of rash and fever with subsequent cardiovascular complications.